Absence Seizures, Once Called Petit Mal

An absence seizure is a brief, sudden lapse of awareness that starts on both sides of the brain. The older name was petit mal.

Important: This article is educational and is not medical advice. It does not diagnose, treat, prevent, or cure any condition. Komori is not a medical device, is not FDA-cleared, does not detect seizures, and is not intended for people with epilepsy. Talk with a neurologist or epileptologist about personal medical decisions. Households living with epilepsy should use clinically validated seizure-detection devices as directed by their care team.

What an absence seizure is

ILAE classifies absence as a generalized-onset, nonmotor seizure. Generalized means it engages both sides of the brain from the start. Nonmotor means the main feature is not stiffening or jerking, even if the eyelids flutter or the hands make small movements.

CDC describes absence seizures as short, sudden lapses of consciousness that often go unnoticed. Someone may stare into space, blink quickly, or make chewing or hand movements. An older term is petit mal. ILAE dropped that label because it was used for too many different brief events, including some focal seizures.

The 2017 instruction manual's glossary is more specific. A typical absence starts suddenly. Ongoing activity stops. There is a blank stare, sometimes a brief upward eye movement. The person usually does not respond when spoken to. Duration is a few seconds to half a minute, with very rapid recovery. If EEG is available, it shows generalized epileptiform discharges during the event.

A blank stare is not, by itself, an absence seizure. Focal impaired awareness seizures can look similar. The word absence is reserved for this generalized type.

Typical and atypical, and two related forms

ILAE kept a split that clinicians still use.

Typical absence starts and ends abruptly. Tone does not change much. Recovery is fast.

Atypical absence has a slower start or finish, or a more obvious change in tone. EEG, when it is done, often shows slower, irregular generalized spike-and-wave activity. Atypical absence is more often tied to developmental and epileptic encephalopathies such as Lennox-Gastaut syndrome, not to uncomplicated childhood absence epilepsy.

Two other named forms sit in the same nonmotor column:

• Myoclonic absence, with rhythmic jerking, often of the arms, during the lapse.
• Absence with eyelid myoclonia, forced upward jerking of the eyelids, often triggered by eye closure or light, as in Jeavons syndrome.

Those last two are specialist diagnoses. If a family says "her eyelids flutter and she is gone for a few seconds," that is useful history. The label belongs to the neurologist.

Who tends to have them

NINDS describes absence epilepsy as repeated momentary lapses of awareness that almost always begin in childhood or adolescence and often run in families. Some children have no obvious movement beyond a stare. Others have a jerking arm or rapid blinking. Right after the event, the child can usually pick up where they left off.

Frequency can be high. NINDS notes that in some cases seizures occur 100 or more times a day, enough to interrupt school even when each event is short.

Childhood absence epilepsy often stops around puberty. NINDS also says some children continue to have absence seizures as adults, or later develop other seizure types. Juvenile absence epilepsy and juvenile myoclonic epilepsy are related generalized syndromes that a pediatric neurologist or epileptologist may consider when onset is later or when myoclonic jerks and tonic-clonic seizures join the picture.

This article will not rank medicines or name a best treatment. Those decisions depend on syndrome, EEG, age, and other health factors.

How absence differs from daydreaming and from focal seizures

Teachers and parents often meet this problem first as "they are not paying attention."

Daydreaming can usually be interrupted. You say the child's name, you touch a shoulder, they come back and look a little sheepish. An absence seizure typically cannot be interrupted that way. It starts and stops on its own.

Focal impaired awareness seizures can also look like a stare. A few practical differences show up in clinic histories, even before EEG:

• Absence usually has no warning. Focal impaired awareness seizures may start with an aura.
• Absence recovery is almost immediate. Focal impaired awareness seizures more often leave a stretch of confusion.
• Absence events can stack many times a day. Focal impaired awareness seizures are often less frequent and last longer.

None of those rules is perfect. ILAE says typical absence tends to occur in younger people, starts and ends more suddenly, and usually has less complex automatisms than a focal impaired awareness seizure. EEG may still be required.

If you are the one watching, write down duration, whether you could interrupt it, what the eyes and hands did, and how the person was 30 seconds later. That note is more useful than a label.

First aid and safety

Most isolated absence seizures need no emergency first aid. Stay nearby. Keep the person out of traffic, water, and machinery. Do not shake them to "snap them out of it." When the event ends, they are usually already back.

Clusters are different. If lapses stack so the person stays confused, treat that as a safety problem. Get them to a safe place. Take dangerous objects out of their hands. Pull them out of sports or water until they are clearly themselves again.

Very rarely, absence can continue as absence status epilepticus, a form of nonconvulsive status. NINDS describes nonconvulsive status as a long episode of confusion, agitation, reduced consciousness, or even coma, diagnosed with EEG. That is a medical emergency, even without shaking.

Call 911 if a seizure of any type lasts more than 5 minutes, if another starts before recovery, if the person is injured, or if this is a first unknown event.

What to take to the neurologist

A phone video of a typical event, if you can record one safely, is often more helpful than a secondhand description. Ask the school to note times of day. Mention family history of seizures or staring spells. Mention any jerks on waking, which can point toward juvenile myoclonic epilepsy rather than childhood absence alone.

Diagnosis is clinical plus EEG. Do not start, stop, or change medicine based on an article.

FAQ

Are absence seizures the same as petit mal?

Petit mal is the older popular term. ILAE no longer uses it as a type name, because it was applied to more than one kind of brief seizure. The current name is absence, with typical and atypical subtypes.

Can adults have absence seizures?

Yes. Many childhood absence epilepsies resolve around puberty, but NINDS notes that some people continue to have absence seizures in adulthood or develop other generalized seizure types.

How can I tell absence from a focal staring spell?

You often cannot, not with certainty. Immediate recovery and no warning lean toward absence. An aura and a confused after-period lean toward a focal impaired awareness seizure. EEG is how clinicians confirm the difference.

Do absence seizures cause a fall?

Typical absence usually does not. Atypical absence can change tone more clearly. Any unexplained fall still needs a clinician's review, because atonic and tonic seizures are different types.

Is first aid needed?

For a single brief absence, stay and keep the person safe. Call for emergency help if events cluster without recovery, last beyond 5 minutes, or leave the person injured or unable to wake fully.

Sources

• CDC, Types of Seizures: https://www.cdc.gov/epilepsy/about/types-of-seizures.html
• CDC, First Aid for Seizures: https://www.cdc.gov/epilepsy/first-aid-for-seizures/index.html
• NINDS, Epilepsy and Seizures: https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures
• Fisher RS et al., Operational classification of seizure types by the ILAE. Epilepsia. 2017;58(4):522-530: https://www.ilae.org/files/dmfile/Operational-Classification--Fisher_et_al-2017-Epilepsia.pdf
• Fisher RS et al., Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58(4):531-542: https://discovery.ucl.ac.uk/id/eprint/10061387/1/Fisher_Classification%20manual%202017-final.pdf
• Epilepsy Foundation, Absence Seizures (resource pointer): https://www.epilepsy.com/what-is-epilepsy/seizure-types/absence-seizures

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